A few weeks after the attacks of September 11, 2001 took the lives of nearly 3,000 people in New York, Washington, DC and a field in rural Pennsylvania, a photo editor named Bobby Stevens at a South Florida-based supermarket tabloid newspaper was hospitalized with a mysterious illness. It was unfamiliar to local physicians who had little reason to expect it, let alone have the tools to treat it. By the time Stevens died, within a few days of his admission, a national investigation was underway.

Former U.S. Senate Majority Leader Tom Daschle

By that time doctors had confirmed the illness was anthrax, and U.S. Centers for Disease Control and Prevention epidemiologists had concluded that the disease-carrying spores had been sent to the tabloid in an ordinary business envelope. By that time also, envelopes carrying anthrax spores had arrived at the offices of major media outlets in New York City, and more were on their way to the U.S. Capitol offices of then Senate Majority Leader Tom Daschle, and Sen. Patrick Leahy. By the time the attack had ended, five people had been killed, a reported 17 more had been infected, about 10,000 people had been given preventive antibiotics, the U.S. Capitol as well as U.S. post office buildings and offices of news outlets had been closed, and the attack remained officially unsolved for another seven years.

Last week, former Sen. Daschle spoke at the Bipartisan Policy Center, to discuss the legislation inspired by the attack, and the potential for a biomedical terrorist attack or pandemic to wreak far more devastating consequences today.

He quoted a recent Bill Gates observation that an airborne pathogen could have greater destructive capacity than an atom bomb. “Yet we don’t look at it nearly the same way,” Daschle added.

The irony, he added, is that the country is arguably less prepared to confront such an event than it was a decade ago — just six years following the anthrax attack. One reason Daschle believes that efforts — and funding — to build protective biomedical preparedness have not kept pace with necessary urgency, is that the need for wide-scale preparedness has yet to be demonstrated. On the other hand, he added, “We’ve had an atom bomb.”

Former New Hampshire Sen. Judd Gregg at the Bipartisan Policy Center

His fellow panelist was former Sen. Judd Gregg, who led the drive to pass Project BioShield Act of 2004, which created a 10-year, $5.6 billion fund to encourage the development of medicines and vaccines against biomedical threats that, while not currently presenting a likely long-term market for pharmaceutical products, have been deemed likely candidates to do large-scale harm. Gregg also has thought about why the need for the legislation, for which the original dedicated funding expired three years ago, has been forgotten.

In the aftermath of both the terrorist attacks of September 11, 2001, and what was subsequently believed to be the “lone wolf” anthrax attack, the Bioshield legislation enjoyed wide bipartisan support, Gregg noted. On the other hand, unlikely to be fully appreciated until fully needed, it was not the kind of legislative contribution that makes political careers; Gregg doubts that 10 of his constituents in New Hampshire knew that he had spearheaded the act, or know why that was a good thing. “Harm prevention,” he said, “is tough to run on.”

But, Gregg said, between 2004 when the legislation was enacted, and 2013 when its initial authorization ended, it backed the development and availability of about a dozen “medical counter measures” against specific pathogens with the potential to pose wide threats. But the legislation was refunded for a shorter term — 2.8 billion for five years — some of which was then accessed for other emergency preparedness measures. That precedent, both former legislators said, leaves the funding vulnerable, and makes it a less reliable source of support for the kind of long-range biomedical research, development and stockpiling of medicines and vaccines that it is meant to support. The answer, both suggested, lies in further large-scale, long-term funding, a hard sell in the current political environment.

“How do we get Congress thinking this way again without a crisis?” Daschle said. “We need a fund,” he added, “so we don’t have to go back to Congress.”

“No kidding,” said a man in the audience, who later identified himself as “a physician scientist working on the street level.”

“There’s a narrow band between apathy and paralyzing dread,” Bipartisan Policy Center President Jason Grumet, who was moderating the discussion, offered.

“People are lulled into the belief it’s being taken care of,” Daschle said. “At the end of the day, most Americans think the government’s doing its job.”

Tom Daschle and Judd Gregg probably don’t know this, but it might already be possible to reduce mortality from many of the biomedical terrorist and pandemic threats for which Project Bioshield was created. Inexpensive generic drugs like stains and angiotensin receptor blockers apparently reduced mortality in patients with Ebola (see Fedson DS Ann Transl Med 2016; 4: 421; available online). Many of the emerging threats listed by Project Bioshield (including inhalation anthrax) cause harm by acting on common molecular pathways in the human host. For this reason, these and similar generic drugs might also be life saving. Unfortunately, no one in government (NIH,CDC, BARDA, DoD) seems interested in this approach to treatment. Instead, they focus on discovering new treatments that will cost millions to develop and produce. It would be far better to spend at least a little bit of time and money on studies of inexpensive drugs that are known to be safe in people with critical illness and that physicians use every day. This “bottom up” approach to managing these emerging threats has a solid scientific rationale. What is missing is the imagination to understand that simple, inexpensive measures might provide a large measure of security against these threats. Why is this so?